TY - JOUR

T1 - Brain Oxygen Supply in Older Adults During Coronary Artery Bypass Grafting

AU - Kamenskaya, Oksana

AU - Klinkova, Asya

AU - Loginova, Irina

AU - Lomivorotov, Vladimir V.

AU - Shmyrev, Vladimir

AU - Chernyavskiy, Alexander

N1 - Publisher Copyright: © 2020 Elsevier Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/12

Y1 - 2020/12

N2 - Objectives: To evaluate the dynamics of the cerebral oxygen supply in patients aged ≥65 years, during coronary artery bypass grafting (CABG), and to test the hypothesis that lower intraoperative brain oxygen saturation is associated with postoperative neurological complications. Design: Prospective cohort study. Setting: The E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia. Participants: The study comprised 200 elderly patients who underwent CABG between April, 2018 and November, 2019. Interventions: None. Measurements and Main Results: The regional hemoglobin oxygen saturation (rSO2, %) of the right and left brain hemispheres were assessed during the intraoperative period using bilateral near-infrared spectroscopy. Furthermore, neurological complications during hospitalization were evaluated. At the anesthesia induction stage, the average levels of rSO2 for the right and left hemispheres were within 65% and did not differ significantly at any stage of CABG (p>0.05). The risk of neurological complications was associated with rSO2 decrease during cardiopulmonary bypass (CPB). An increased risk was associated with rSO2 decrease by 20% or more during CPB, relative to the stage of anesthesia induction, which was observed in 19% of patients. Conclusions: In elderly patients, the decrease in rSO2 during CPB is associated with an increased risk of neurological complications during hospitalization. This risk increases with a decrease in rSO2 by 20% or more during CPB relative to the stage of anesthesia induction, by a 5-fold and 7-fold for the left and right hemispheres, respectively.

AB - Objectives: To evaluate the dynamics of the cerebral oxygen supply in patients aged ≥65 years, during coronary artery bypass grafting (CABG), and to test the hypothesis that lower intraoperative brain oxygen saturation is associated with postoperative neurological complications. Design: Prospective cohort study. Setting: The E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia. Participants: The study comprised 200 elderly patients who underwent CABG between April, 2018 and November, 2019. Interventions: None. Measurements and Main Results: The regional hemoglobin oxygen saturation (rSO2, %) of the right and left brain hemispheres were assessed during the intraoperative period using bilateral near-infrared spectroscopy. Furthermore, neurological complications during hospitalization were evaluated. At the anesthesia induction stage, the average levels of rSO2 for the right and left hemispheres were within 65% and did not differ significantly at any stage of CABG (p>0.05). The risk of neurological complications was associated with rSO2 decrease during cardiopulmonary bypass (CPB). An increased risk was associated with rSO2 decrease by 20% or more during CPB, relative to the stage of anesthesia induction, which was observed in 19% of patients. Conclusions: In elderly patients, the decrease in rSO2 during CPB is associated with an increased risk of neurological complications during hospitalization. This risk increases with a decrease in rSO2 by 20% or more during CPB relative to the stage of anesthesia induction, by a 5-fold and 7-fold for the left and right hemispheres, respectively.

KW - cerebral oxygen saturation

KW - coronary artery bypass grafting

KW - elderly patients

KW - neurological complications

UR - http://www.scopus.com/inward/record.url?scp=85086178616&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2020.04.053

DO - 10.1053/j.jvca.2020.04.053

M3 - Article

C2 - 32532692

AN - SCOPUS:85086178616

VL - 34

SP - 3275

EP - 3281

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 12

ER -